Localising neurological problem!

Re: Localising neurological problem!

Bob Russell — Wed, 27 Nov 2013 14:11:36 GMT

If I could be convinced there is pain or even discomfort I would be far less in the dark!

Re: Localising neurological problem!

Anthony Dennison — Wed, 27 Nov 2013 13:15:04 GMT

If mentation is normal, how was temperature? I'd say C1-C5, possibly even C6-T2? Could just be a knock the dog has taken.

I've had a similar situation, though it was with a pelvic limb in a little dog. They were insured, but not much so full referral investigations would have stretched them. I gave steroids at 0.5mg/kg for 5 days, then if still a little wobbly use an NSAID. If dogs do show neck pain or are tender/tense I sometimes give 2mg/dog diazepam as skeletal muscle relaxation, does seem to help if is a trapped nerve

Re: Localising neurological problem!

Bob Russell — Wed, 27 Nov 2013 12:55:21 GMT

Bright and normal mentation at all stages. No neck discomfort. Can move neck freely without discomfort. No yelping or pain. Dog will jump up at the owner without reticence or obvious weakness.

If anything the dog has improved somewhat.

Many thanks for the advice! I would love to refer but the owner is unlikely to be able to go for advanced imaging.

Re: Localising neurological problem!

Mark Lowrie — Wed, 27 Nov 2013 11:49:25 GMT

Not sure I can say too much more with the video as it just confirms a lack of proprioception in the left pelvic limb. First question is always - is it neurological. I get this by observing the gait and seeing if other signs are present, e.g. yelping/pain, loss of learned behaviour (e.g. toileting in house) and ensuring no medical problem is present that may cause profound weakness. Doing a neurological examination on a sick medical case can often give misleading results such as loss of proprioception, decreased reflexes etc.

However, if we assume this dog is neurological with a proprioceptive deficit in the left pelvic limb then the likely neurological localisation is cervical spinal cord or brain. To distinguish the two it would be important to ask questions concerning brain disease e.g. has the dog been dull at home, has it toileted in the house, has it been bumping into things etc? If it has any of these concerns then a brain lesion is most likely and in a dog like this, in which signs are progressive, the most common causes would be an inflammatory brain disease (meningoencephalitis of unknown origin/GME), and neoplasia. However, other causes do occur they are just less common. If the dog is BAR with no 'brain' signs then a cervical localisation is possible. It would therefore be important to move the head through a full range of movement to the right, left and up and down to assess for cervical discomfort. If this is present then cervical painful diseases most likely to occurring a dog like this would be disc disease, neoplasia, discospondylitis or meningomyelitis. If it is non-painful, neoplasia and meningoemyelitis remain a possibility. Given the dog can walk and is only mildly affected I would suggest monitoring is the best thing to do and if the gait becomes more severe then posting a video here of the gait would be useful.

Sorry I cannot be of more help. Unfortunately the signs remain relatively vague at the moment and I cannot rule-out the possibility of a non-neurological problem.

Re: Localising neurological problem!

Hannah Wynne Richards — Wed, 27 Nov 2013 11:08:49 GMT

Bob Don't be ashamed of your lack of expertise with youtube.Youve done better than I would have managed - humiliating how these youngsters manage it !!!!!!!!!!!!!!!!

Wynne

Re: Localising neurological problem!

Arlo Guthrie — Wed, 27 Nov 2013 10:27:47 GMT

I've tweaked the video. You should be able to see it now, Mark.

Bob, you need to copy JUST the part of the youtube url that includes the unique code for the video, in this case: http://www.youtube.com/watch?v=wl63BXdacVo

Don't copy anything beyond that o

Then paste into 'insert media' 'link from url'

Re: Localising neurological problem!

Bob Russell — Tue, 26 Nov 2013 12:34:13 GMT

Sorry the lefts and right are not as clear cut as my notes! First time i have seen the videos as I don't own the iphone.

She moves quite normally, perhaps a little unsteady but nothing that obvious! Next time will use my phone but the charger was left unplugged when it was PAT tested!

Re: Localising neurological problem!

Mark Lowrie — Tue, 26 Nov 2013 12:28:42 GMT

Hi Bob, I'm afraid I can't help with the video thing. I can't get the link above to work. However, sounds from your post that you have recorded a neuro exam. It would be fine just to show a short clip of the dog's gait as this would be most useful and easier to interpret than a neuro exam.

Re: Localising neurological problem!

Bob Russell — Tue, 26 Nov 2013 12:28:19 GMT

www.youtube.com/watch

Re: Localising neurological problem!

Bob Russell — Tue, 26 Nov 2013 12:22:00 GMT

First video calls me liar! This looks bilateral. I am uploading another file. Most of the time the right fore was placed normally.

Re: Localising neurological problem!

Bob Russell — Tue, 26 Nov 2013 11:59:23 GMT

http://youtu.be/c8wbV-WLrFw

Just done a 90 second crash course in YouTube so will try that!

Bloods just back TT4 8. ALT 49 (N.0-25) GLDH 32 (N. 0-10) Bile Acids 23 (N.0.1-10.0)Chol 2.8 (N.3.8-7). Others WNL.

A peripheral neuropathy? Seems pretty sudden onset for that to me.

Re: Localising neurological problem!

Kirsten Simpson — Tue, 26 Nov 2013 11:54:41 GMT

What about using instagram etc for uploading movies, then linking from there?

Re: Localising neurological problem!

Bob Russell — Tue, 26 Nov 2013 11:45:34 GMT

Trying to upload but is a MOV file from an iphone. Seems to be taking forever so may need more advice on getting the file uploaded!!

Placing reflexes were brisk both forelegs last night.

Hind limb placing reflexes, hopping unremarkable.

Re: Localising neurological problem!

Mark Lowrie — Tue, 26 Nov 2013 11:38:32 GMT

I think the advice of the other two posters is good. However, without a video I think unfortunately these symptoms are a bit too vague to say much more. Could you try and post it here or set up a link to another website?

Re: Localising neurological problem!

Robin Grimmer — Mon, 25 Nov 2013 23:31:40 GMT

Right forebrain lesion? What is the motor function like in each leg? Ie can it bear weight if you hold up various legs so all the weight is on one or two legs? Should help you narrow it down. GME maybe in this breed.

Re: Localising neurological problem!

Busybee — Mon, 25 Nov 2013 22:37:15 GMT

Mainly bumping this as I want to see what the experts say!

My two pennies worth: ataxia - sensory, vestibular or cerebellar? Doesn't sound like vestibular with a lack of nystagmus and no head tilt. Cerebellar would normally be an obvious wide based stance with intention tremors of the head. Sensory sounds most likely - abnormal postural reactions and limb paresis; unfortunately, this doesn't necessarily narrow down the localisation! It would be interesting to see what the spinal reflexes are like in the forelimbs. This could be a multifocal lesion or two distinct lesions?

Would be interested to see the video!